Evaluation of Bromelain-Based Enzymatic Debridement Combined with Laser Doppler Imaging and Healing of Burn Wounds

Abstract

Background Accurate estimation of burn depth is crucial for correct treatment decision making. Bromelain-based enzymatic debridement (ED) may improve clinical assessment of burn depth. Laser Doppler imaging (LDI) provides a valuable indicator of burn depth by analyzing microcirculation within tissue beds. This study aimed to evaluate bromelain-based enzymatic debridement combined with laser Doppler imaging and healing of 42 wounds in 19 patients with mixed second- and third-degree thermal burns. Material/Methods We included 42 wounds in 19 patients with mixed deep dermal and full-thickness thermal burns. All patients were treated with eschar-specific removal agent for ED. The perfusion of each wound after ED was assessed using LDI. Healing time was estimated by 2 experienced burn surgeons and marked by the observation of epithelization. The usefulness of the LDI performed after ED in predicting healing time was estimated. The findings were analyzed to determine a cut-off value for LDI that indicates if a burn will heal spontaneously. Results We observed that burn wounds with higher mean perfusion healed faster. The analysis showed a strong relationship between perfusion after ED and healing time (Spearman rank correlation coefficient=−0.803). A mean perfusion greater than 296.89 indicated that the wound could heal spontaneously and does not require skin grafting. Conclusions LDI examination of an already debrided wound allows for a reliable assessment of perfusion at an early stage of treatment. The use of a safe and effective debridement method in conjunction with a non-invasive diagnostic tool could improve burn management.

Current Uses of Bromelain in Children: A Narrative Review

“…Bromelain is a viable alternative to surgical escharotomy for deep burns [ 47 ]. In fact, prompt removal of necrotic tissue leads to better spontaneous healing or better graft application, reducing the risk of infection and improving patient survival [ 71 ]. Infection is the leading cause of death in burn patients, especially in children, due to the compromised skin barrier.…”

“…Infection is the leading cause of death in burn patients, especially in children, due to the compromised skin barrier. In addition, the risk of infection persists until necrotic tissue remains [ 71 ]. Therefore, early eschar debridement within 24 h of the burn significantly reduces the risk of bacterial colonization and infection, especially in pediatric patients.…”

“…However, this procedure can be associated with several complications, such as profuse bleeding with hemodynamic disturbances [ 72 ] or excision of the fascia, leading to significant skin deformity. Therefore, non-surgical eschar removal (abrasive techniques, hydrosurgery, or enzymatic debridement) is useful to minimize the risks associated with this procedure [ 71 ]. Claes et al [ 72 ] found that a bromelain-based debridement agent can selectively remove the necrotic eschar while preserving viable dermal tissue and appendages in the wound bed in deep partial- or full-thickness margins; this results in spontaneous re-epithelialization and improved aesthetic and functional outcomes, especially when compared to tangential excision.…”

“…This topical agent, called anacaulase-bcdb (NexoBrid ® ), contains several proteolytic enzymes enriched with bromelain. It was approved by the European Medicines Agency (EMA) in 2021 for eschar debridement [ 71 ] and by the US Food and Drug Administration (FDA) in 2022 [ 85 ].…”

Bromelain‐based enzymatic burn debridement: A systematic review of clinical studies on patient safety, efficacy and long‐term outcomes

“…57,66,67 Schulz et al in a study with 40 patients with hand burns found superior outcomes post-BBD in burn depth evaluation, tissue preservation, completeness of debridement, and wound closure. 68 Although Laser Doppler Imaging (LDI), 69,70 and ultrasound for assessing skin thickness 71 may be helpful, subjective clinical inspection of the remaining dermal elements is the standard method for assessing the post-enzymatically debrided wound bed.…”